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Bruns EJ, Benjamin PH, Shepler RN, Kellogg M, Pluckebaum H, Woolston JL, English K, Zabel MD. Manuscript: Defining Quality Standards for Intensive Home Based Treatment Programs for Youth with Serious Emotional Disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:1065-1088. [PMID: 34241737 PMCID: PMC8267760 DOI: 10.1007/s10488-021-01116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Intensive Home Based Treatment (IHBT) is a critical component of the continuum of community-based behavioral healthcare for youth with serious emotional disorder (SED) and their families. Yet despite being used nationwide at costs of over $100 million annually in some states, a well-vetted, research-based set of quality standards for IHBT has yet to be developed. The current project aimed to define program and practice standards for IHBT, drawing upon literature review, expert interviews, and a systematic Delphi process engaging over 80 participants, including IHBT developers, experts in evidence-based youth mental health, youth and family advocates, IHBT providers, and state policymakers. After two rounds of quantitative and qualitative input, adequate consensus was achieved on 32 IHBT Program Standards and 43 IHBT Practice Standards. These standards hold potential for informing efforts such as development of state regulations, provider contracts, memoranda of agreement, and training and workforce development initiatives. Translation of the quality standards into measurement strategies holds potential for providing a method of continuous quality improvement across multiple levels as well as use in research on IBHT.
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Affiliation(s)
- Eric J Bruns
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA.
| | - Philip H Benjamin
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Richard N Shepler
- Center for Innovative Practices, Case Western Reserve University, 11402 Bellflower Road, Cleveland, OH, 44106, USA
| | - Marianne Kellogg
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Hunter Pluckebaum
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Joseph L Woolston
- Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT, 06519-1124, USA
| | - Kelly English
- Children's Behavioral Health Knowledge Center, Massachusetts Department of Mental Health, 25 Staniford Street, Boston, MA, 02114, USA
| | - Michelle D Zabel
- School of Social Work, University of Maryland, 306 W. Redwood Street, 2nd Floor, Baltimore, MD, 21202, USA
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Safer DJ. A Critique on Psychiatric Inpatient Admissions for Suicidality in Youth. J Nerv Ment Dis 2021; 209:467-473. [PMID: 34170857 DOI: 10.1097/nmd.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT For the last few decades, psychiatric inpatient admissions for the treatment of suicidality in US youth have been increasing. Nonetheless, since 2007, the national rate of completed suicides by youth has steadily and sizably increased. Therefore, a literature review was performed to evaluate the usefulness of the psychiatric inpatient admission of suicidal youths. The analysis concluded that suicidality is surprisingly common in youth, completed suicide is very uncommon in early adolescence, suicidal ideation is a major reason in early adolescence for inpatient admission, girls are admitted to psychiatric inpatient units three times more than boys even though boys complete suicide four times more than girls, inpatient stays average 6 days and are quite expensive, and repeat attempts after inpatient treatment are common. Thus, filling more beds for youth with suicidality lacks evidence of a public health, long-term benefit. Expanding the focus in psychiatry to population efforts including means reductions is recommended.
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Affiliation(s)
- Daniel J Safer
- Departments of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Graaf G, Snowden L. Public Health Coverage and Access to Mental Health Care for Youth with Complex Behavioral Healthcare Needs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:395-409. [PMID: 31728778 DOI: 10.1007/s10488-019-00995-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Drawing upon the National Survey of Children with Special Healthcare Needs (2009/2010), multilevel logistic regression analysis assessed the relationship between parent report of a youth having an emotional, behavioral, or developmental problem (EBDP), their level of reported functional limitations, and parents' report of unmet mental health care needs and experience with cost-barriers to accessing needed healthcare services. Results indicate that, compared to all privately insured youth with special health care needs, parents of privately insured youth with EBDP are much more likely to report their child having unmet mental health care needs (OR 12.16; p < 0.001) and experiencing cost barriers to care (OR 2.37; p < 0.001). Parents of privately insured youth with EBDP with functional limitations are even more likely to report these concerns (Unmet Mental Health Needs: OR 17.09; p < 0.001; Cost Barriers: OR 5.77; p < 0.001). However, findings suggest that having public insurance is associated with reductions in the odds of having unmet needs for youth with SED by 50%. Public insurance and dual coverage is associated with reductions in the odds of encountering cost barriers to care by almost 50% for children with EBDP, and by more 50% for youth with EBDP and functional impairments.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Social Work Complex - A, 112D, 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA.
| | - Lonnie Snowden
- School of Public Health, University of California, Berkeley, USA
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Frank HE, Becker-Haimes EM, Kendall PC. Therapist training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020; 27:e12330. [PMID: 34092941 PMCID: PMC8174802 DOI: 10.1111/cpsp.12330] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
A lack of effective therapist training is a major barrier to evidence-based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train-the-trainer, and intensive training) affect therapists' knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.
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Affiliation(s)
- Hannah E. Frank
- Psychology Department, Temple University, Philadelphia, Pennsylvania
| | - Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Hall Mercer Community Mental Health, Philadelphia, Pennsylvania
| | - Philip C. Kendall
- Psychology Department, Temple University, Philadelphia, Pennsylvania
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Leffler JM, D'Angelo EJ. Implementing Evidence-Based Treatments for Youth in Acute and Intensive Treatment Settings. J Cogn Psychother 2020; 34:185-199. [PMID: 32817401 DOI: 10.1891/jcpsy-d-20-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence-based treatments (EBTs) have been well studied in outpatient and research settings to address a myriad of mental health concerns. Research studies have found benefits and challenges when implementing these interventions. However, less is known about the implementation of EBTs in acute and intensive treatment settings such as inpatient psychiatric hospitalization (IPH) units, partial hospitalization programs (PHPs), or intensive outpatient programs (IOPs). As a result, the specific benefits and challenges of providing EBTs in these settings are less clear. For example, challenges of implementing EBTs in IPHs, PHPs, and IOPs can include working within a multi-disciplinary team setting and sustaining trained staff. The current article provides an overview of implementing EBTs in IPHs PHPs, and IOPs. Current PHP, IOP, and IPH models of implementing evidence-based interventions along with strategies for engaging stakeholders, program development and implementation, and measurement are reviewed. Further considerations for sustainability and practice consideration are also provided.
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Affiliation(s)
| | - Eugene J D'Angelo
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Gameon JA, Skewes MC. A Systematic Review of Trauma Interventions in Native Communities. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 65:223-241. [PMID: 31518009 PMCID: PMC7243818 DOI: 10.1002/ajcp.12396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
American Indian/Alaska Native and First Nations communities suffer from health disparities associated with multiple forms of trauma exposure. Culturally appropriate interventions are needed to heal current and historical trauma wounds. Although there are evidence-based trauma interventions for other populations, few have been implemented or evaluated with Native communities. Understanding the extant research on trauma interventions in Native communities is crucial for advancing science and filling gaps in the evidence base, and for meeting the needs of underserved people. In this systematic review of the literature on trauma interventions in Native communities in the United States, Canada, Australia, and New Zealand, we identified 15 studies representing 10 interventions for historical and/or current trauma. These studies involved the community to some extent in developing or culturally adapting the interventions and suggested positive outcomes with regard to historical and interpersonal trauma symptoms. However, notable limitations in study design and research methods limit both internal validity and external validity of these conclusions. Only one study attempted (but did not achieve) a quasi-experimental design, and small sample sizes were persistent limitations across studies. Recommendations for researchers include working in partnership with Native communities to overcome barriers to trauma intervention research and to increase the rigor of the studies so that ongoing efforts to treat trauma can yield publishable data and communities can secure funding for intervention research.
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Affiliation(s)
- Julie A Gameon
- Department of Psychology, Montana State University, Bozeman, MT, USA
| | - Monica C Skewes
- Department of Psychology, Montana State University, Bozeman, MT, USA
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Campbell LA, Clark SE, Ayn C, Chorney J, Emberly D, MacDonald J, MacKenzie A, Marsh D, Peacock K, Wozney L. The Choice and Partnership Approach to community mental health and addictions services: a realist-informed scoping review protocol. BMJ Open 2019; 9:e033247. [PMID: 31874887 PMCID: PMC7008451 DOI: 10.1136/bmjopen-2019-033247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/25/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Early identification and appropriate treatment of child and adolescent mental health disorders can often be hampered by patchwork services with poorly planned or unclear pathways. The Choice and Partnership Approach (CAPA) is an evidence-based transformational model of community (community-based or outpatient) mental health and addictions services for children and adolescents that aims to better match services to needs and to improve timely access to care. CAPA has been variably implemented across jurisdictions but has not been comprehensively evaluated for its impact on system and client outcomes. Our research question is, 'To what degree does CAPA work, for whom and under what circumstances?'. The purpose of this review is twofold: (1) to gain an understanding of the extent and outcomes of the implementation of CAPA in community mental health and addictions services; and (2) to identify the role of context as it influences the implementation of CAPA and resulting client and system outcomes. METHODS AND ANALYSIS We will conduct a realist-informed scoping review of the literature related to CAPA in either child and adolescent or adult community mental health and addictions services. Relevant studies, reports and documentation will be identified by searching the following online databases: MEDLINE, Embase, CINAHL, PsycINFO, Academic Search Premier, ERIC, Web of Science, Cochrane, Dissertations Abstracts, NCBI Bookshelf, PubMed Central and the Canadian Health Research Collection. The search strategy was developed by a health sciences library scientist and informed by a multidisciplinary team comprising methodological and content knowledge experts. The search will gather evidence from multiple online databases of peer-reviewed literature and grey literature repositories. All articles will be independently assessed for inclusion by pairs of reviewers. The key themes derived from a thematic analysis of extracted data will be presented in a narrative overview. ETHICS AND DISSEMINATION Research ethics review is not required for this scoping review. The results will be disseminated through meetings with stakeholders (including clients and families, clinicians and decision-makers), conference presentations and peer-reviewed publication. The results of this review will inform an overarching programme of research, policy and quality indicator development to ultimately improve mental health and addictions care and subsequent mental health outcomes for children and adolescents.
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Affiliation(s)
- Leslie Anne Campbell
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Psychiatry, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Caitlyn Ayn
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Mental Health and Addictions, IWK Health Centre, Halifax, Nova Scotia, Canada
- Anesthesia, Pain Management & Perioperative Medicine, and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Debbie Emberly
- Mental Health and Addictions, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Julie MacDonald
- Mental Health and Addictions, Nova Scotia Health Authority, Sydney, Nova Scotia, Canada
| | - Adrian MacKenzie
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Health Workforce Planning and Regulatory Affairs Branch, Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Daniel Marsh
- Administration, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kylie Peacock
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Mental Health and Addictions, Nova Scotia Health Authority, Dartmouth, Nova Scotia, Canada
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White C, Goldberg V, Hibdon J, Weisburd D. Understanding the role of service providers, land use, and resident characteristics on the occurrence of mental health crisis calls to the police. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1961-1982. [PMID: 31508829 PMCID: PMC6791365 DOI: 10.1002/jcop.22243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Similar to concentrations of crime, mental health calls have been found to concentrate at a small number of places, but few have considered the context of places where mental health calls occur. The current study examines the influence of the physical and social context of street segments, particularly the role of service providers, land use features of the street and nearby area, and characteristics of residents on the likelihood of a mental health crisis call to the police occurring on the street. The findings demonstrate that the social context, such as offending and drug use among residents, levels of social cohesion and community involvement, and drug and violent crime influenced the occurrence of mental health crisis calls. Findings from this study make theoretical and practical contributions to a number of disciplines by improving our understanding of where mental health crisis calls occur and why they are found at specific places.
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Affiliation(s)
- Clair White
- Department of Criminal Justice and Sociology, University of Wyoming, Laramie WY
| | - Victoria Goldberg
- Department of Criminology, Law, & Society, George Mason University, Fairfax VA
| | - Julie Hibdon
- Department of Criminology and Criminal Justice, Southern Illinois University, Carbondale, IL
| | - David Weisburd
- Department of Criminology, Law, & Society, George Mason University, Fairfax VA
- Institute of Criminology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel
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Stewart SL, Poss JW, Thornley E, Hirdes JP. Resource Intensity for Children and Youth: The Development of an Algorithm to Identify High Service Users in Children's Mental Health. Health Serv Insights 2019; 12:1178632919827930. [PMID: 30828248 PMCID: PMC6390227 DOI: 10.1177/1178632919827930] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
Abstract
Children’s mental health care plays a vital role in many social, health care, and
education systems, but there is evidence that appropriate targeting strategies
are needed to allocate limited mental health care resources effectively. The aim
of this study was to develop and validate a methodology for identifying children
who require access to more intense facility-based or community resources.
Ontario data based on the interRAI Child and Youth Mental Health instruments
were analysed to identify predictors of service complexity in children’s mental
health. The Resource Intensity for Children and Youth (RIChY) algorithm was a
good predictor of service complexity in the derivation sample. The algorithm was
validated with additional data from 61 agencies. The RIChY algorithm provides a
psychometrically sound decision-support tool that may be used to inform the
choices related to allocation of children’s mental health resources and
prioritisation of clients needing community- and facility-based resources.
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Affiliation(s)
| | - Jeff W Poss
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
| | | | - John P Hirdes
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
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Balkin RS. A Reexamination of Trends in Acute Care Psychiatric Hospitalization for Adolescents: Ethnicity, Payment, and Length of Stay. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/15566382.2006.12033823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Markota M, McKean AJ, Romanowicz M, Schak KM, Croarkin PE, Vande Voort JL. Rehospitalization to a child and adolescent psychiatry unit: Role of trauma and bullying. Gen Hosp Psychiatry 2018; 55:10-14. [PMID: 30193205 DOI: 10.1016/j.genhosppsych.2018.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Psychiatric rehospitalizations results in a significant burden to patients, families, and health care systems. Understanding psychiatric rehospitalizations offers an opportunity to identify weaknesses in current systems of care. The objective of this study was to test the hypothesis that a history of trauma or ongoing bullying increases the risk of psychiatric rehospitalization. METHOD Retrospective cohort study of 366 individual patients (71% female) admitted to a pediatric psychiatry unit between 1/1/2015 and 12/31/2015. The primary outcome measure was rehospitalization to the same psychiatric hospital unit within one year of first discharge. Trauma was defined as having a history of Post-Traumatic Stress Disorder, Reactive Attachment Disorder, or a filed Suspected Abuse and Neglect of a Child report by the end of first hospitalization. Ongoing bullying was identified by medical record review. RESULTS History of trauma (Odds Ratio (OR) = 3.2, 95% Confidence Interval (CI) = 1.8-5.6, p < 0.0001) and ongoing bullying (OR = 2.2, CI = 1.2-3.9, p = 0.009) were significantly associated with increased rates of rehospitalizations. We controlled for the following covariates: Patient Health Questionnaire-9 Modified (PHQ-9M) score, gender, age, relative age, initial length of stay, disrupted family system, and sexual orientation/identity. CONCLUSION History of trauma or ongoing bullying are important risk factors for pediatric psychiatric rehospitalization.
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Affiliation(s)
- Matej Markota
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Solmi F, Melnychuk M, Morris S. The cost of mental and physical health disability in childhood and adolescence to families in the UK: findings from a repeated cross-sectional survey using propensity score matching. BMJ Open 2018; 8:e018729. [PMID: 29391378 PMCID: PMC5829601 DOI: 10.1136/bmjopen-2017-018729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE In the UK, families of disabled children are entitled to receive disability benefits to help meet costs associated with caring for their child. Evidence of actual costs incurred is scant, especially for mental health disability. In this study, we aimed to quantify the cost of mental and physical health disability in childhood and adolescence to families in the UK using the concept of compensating variation (CV). DESIGN Repeated cross-sectional survey. SETTING The UK general population PARTICIPANTS: 85 212 children drawn from 8 waves of the Family Resources Survey. OUTCOMES Using propensity score matching we matched families with a disabled child to similar families without a disabled child and calculated the extra income the former require to achieve the same living standards as the latter, that is, their CV. We calculated the additional costs specifically associated with several definitions of mental health and physical health disability. RESULTS Families of a child with any mental health disability, regardless of the presence of physical health comorbidity, needed an additional £49.31 (95% CI: 21.95 to 76.67) and, for more severe disabilities, an additional £57.56 (95% CI: 17.69 to 97.44) per week to achieve the same living standards of families without a disabled child. This difference was greater for more deprived families, who needed between £59.28 (95% CI: 41.38 to 77.18) and £81.26 (95% CI: 53.35 to 109.38) more per week depending on the extent of mental health disability. Families of children with physical health disabilities, with or without mental health disabilities, required an additional £35.86 (95% CI: 13.77 to 57.96) per week, with economically deprived families requiring an extra £42.18 (95% CI: 26.38 to 57.97) per week. CONCLUSIONS Mental and physical health disabilities among children and adolescents were associated with high additional costs for the family, especially for those from deprived economic backgrounds. Means testing could help achieve a more equitable redistribution of disability benefit.
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Affiliation(s)
- Francesca Solmi
- Division of Psychiatry, University College London, London, UK
| | - Mariya Melnychuk
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
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Kaehler LA, Jacobs M, Jones DJ. Distilling Common History and Practice Elements to Inform Dissemination: Hanf-Model BPT Programs as an Example. Clin Child Fam Psychol Rev 2018; 19:236-58. [PMID: 27389606 DOI: 10.1007/s10567-016-0210-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is a shift in evidence-based practice toward an understanding of the treatment elements that characterize empirically supported interventions in general and the core components of specific approaches in particular. The evidence base for behavioral parent training (BPT) and the standard of care for early-onset disruptive behavior disorders (oppositional defiant disorder and conduct disorder), which frequently co-occur with attention deficit hyperactivity disorder, are well established, yet an ahistorical, program-specific lens tells little regarding how leaders, University of Oregon Medical School, shaped the common practice elements of contemporary evidence-based BPT. Accordingly, this review summarizes the formative work of Hanf, as well as the core elements, evolution, and extensions of her work, represented in Community Parent Education (COPE; (Cunningham et al. in J Child Psychol Psychiatry 36:1141-1159, 1995; Cunningham et al. in COPE, the community parent education program: large group community-based workshops for parents of 3- to 18-year-olds, COPE Works, Hamilton, 2009), Defiant Children (DC; (Barkley in Defiant children: a clinician's manual for assessment and parent training, Guilford Press, New York, 1987; Barkley in Defiant children: a clinician's manual for assessment and parent training, Guilford Press, New York, 2013), Helping the Noncompliant Child (HNC; Forehand and McMahon in Helping the noncompliant child: a clinician's guide to parent training, Guilford Press, New York, 1981; McMahon and Forehand in Helping the noncompliant child: family-based treatment for oppositional behavior, 2nd ed., Guilford Press, New York, 2003), Parent-child interaction therapy (PCIT; Eyberg and Robinson in J Clin Child Adolesc Psychol 11:130-137, 1982. doi:10.1080/15374418209533076; Eyberg in Child Fam Behav Ther 10:33-46, 1988; Eyberg and Funderburk in Parent-child interaction therapy protocol, PCIT International, Gainesville, 2011), and the Incredible Years (IY; (Webster-Stratton in Behav Ther 12:634-642, 1981. doi:10.1016/S0005-7894(81)80135-9; Webster-Stratton in J Pediatr Psychol 7:279-294, 1982. doi:10.1093/jpepsy/7.3.279; Webster-Stratton in The incredible years: parents and children series. Leader's guide: preschool version of BASIC (ages 3-6 years, The Incredible Years, Seattle, 2008). Our goal is not to provide an exhaustive review of the evidence base for the Hanf-Model programs, rather our intention is to provide a template of sorts from which agencies and clinicians can make informed choices about how and why they are using one program versus another, as well as how to make inform flexible use one program or combination of practice elements across programs, to best meet the needs of child clients and their families. Clinical implications and directions for future work are discussed.
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Affiliation(s)
- Laura A Kaehler
- Children's Advocacy Services of Greater St. Louis, University of Missouri, St. Louis, MO, USA
| | - Mary Jacobs
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Bui AL, Dieleman JL, Hamavid H, Birger M, Chapin A, Duber HC, Horst C, Reynolds A, Squires E, Chung PJ, Murray CJL. Spending on Children's Personal Health Care in the United States, 1996-2013. JAMA Pediatr 2017; 171:181-189. [PMID: 28027344 PMCID: PMC5546095 DOI: 10.1001/jamapediatrics.2016.4086] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time. OBJECTIVE To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care. EVIDENCE REVIEW Health care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars. FINDINGS From 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1-155.5) billion to $233.5 (UI, 226.9-239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11 741 (UI, 10 799-12 765) in 2013. Across time, health care spending per child increased from $1915 (UI, 1845-1991) in 1996 to $2777 (UI, 2698-2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions. CONCLUSIONS AND RELEVANCE These findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions.
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Affiliation(s)
- Anthony L. Bui
- David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | | | - Hannah Hamavid
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Maxwell Birger
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Abigail Chapin
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Herbert C. Duber
- Institute for Health Metrics and Evaluation, Seattle, Washington3Division of Emergency Medicine, University of Washington, Seattle
| | - Cody Horst
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Alex Reynolds
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Ellen Squires
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Paul J. Chung
- Departments of Pediatrics and Health Policy and Management, University of California, Los Angeles5RAND Health, RAND Corporation, Santa Monica, California
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Pederson CA, Rathert JL, Fite PJ, Stoppelbein L, Greening L. The Role of Parenting Styles in the Relation Between Functions of Aggression and Internalizing Symptoms in a Child Psychiatric Inpatient Population. Child Psychiatry Hum Dev 2016; 47:819-29. [PMID: 26676142 DOI: 10.1007/s10578-015-0614-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Psychiatric inpatient hospitalization is a costly intervention for youth. With rates of hospitalization rising, efforts to refine prevention and intervention are necessary. Aggression often precedes severe internalizing behaviors, and proactive and reactive functions of aggression are differentially associated with internalizing symptomatology. Thus, further understanding of the links between functions of aggression and internalizing symptomatology could aid in the improvement of interventions for hospitalized youth. The current study examined parenting styles, gender, and age as potential moderators of the relations between proactive and reactive aggression and internalizing symptoms. Participants included 392 children, 6-12 years of age admitted consecutively to a psychiatric inpatient unit. Reactive aggression was uniquely associated with anxiety symptoms. However, proactive aggression was associated with internalizing problems only when specific parenting styles and demographic factors were present. Although both proactive and reactive subtypes of aggression were associated with internalizing symptoms, differential associations were evident. Implications of findings are discussed.
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Affiliation(s)
- Casey A Pederson
- Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Ave, Dole HDC 2006, Lawrence, KS, 66049, USA.
| | | | - Paula J Fite
- Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Ave, Dole HDC 2006, Lawrence, KS, 66049, USA
| | - Laura Stoppelbein
- Glenwood Autism and Behavioral Health and Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leilani Greening
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS, USA
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Kaehler LA, Jacobs M, Jones DJ. Distilling Common History and Practice Elements to Inform Dissemination: Hanf-Model BPT Programs as an Example. Clin Child Fam Psychol Rev 2016. [PMID: 27389606 DOI: 10.1080/15374418209533076.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
There is a shift in evidence-based practice toward an understanding of the treatment elements that characterize empirically supported interventions in general and the core components of specific approaches in particular. The evidence base for behavioral parent training (BPT) and the standard of care for early-onset disruptive behavior disorders (oppositional defiant disorder and conduct disorder), which frequently co-occur with attention deficit hyperactivity disorder, are well established, yet an ahistorical, program-specific lens tells little regarding how leaders, University of Oregon Medical School, shaped the common practice elements of contemporary evidence-based BPT. Accordingly, this review summarizes the formative work of Hanf, as well as the core elements, evolution, and extensions of her work, represented in Community Parent Education (COPE; (Cunningham et al. in J Child Psychol Psychiatry 36:1141-1159, 1995; Cunningham et al. in COPE, the community parent education program: large group community-based workshops for parents of 3- to 18-year-olds, COPE Works, Hamilton, 2009), Defiant Children (DC; (Barkley in Defiant children: a clinician's manual for assessment and parent training, Guilford Press, New York, 1987; Barkley in Defiant children: a clinician's manual for assessment and parent training, Guilford Press, New York, 2013), Helping the Noncompliant Child (HNC; Forehand and McMahon in Helping the noncompliant child: a clinician's guide to parent training, Guilford Press, New York, 1981; McMahon and Forehand in Helping the noncompliant child: family-based treatment for oppositional behavior, 2nd ed., Guilford Press, New York, 2003), Parent-child interaction therapy (PCIT; Eyberg and Robinson in J Clin Child Adolesc Psychol 11:130-137, 1982. doi:10.1080/15374418209533076; Eyberg in Child Fam Behav Ther 10:33-46, 1988; Eyberg and Funderburk in Parent-child interaction therapy protocol, PCIT International, Gainesville, 2011), and the Incredible Years (IY; (Webster-Stratton in Behav Ther 12:634-642, 1981. doi:10.1016/S0005-7894(81)80135-9; Webster-Stratton in J Pediatr Psychol 7:279-294, 1982. doi:10.1093/jpepsy/7.3.279; Webster-Stratton in The incredible years: parents and children series. Leader's guide: preschool version of BASIC (ages 3-6 years, The Incredible Years, Seattle, 2008). Our goal is not to provide an exhaustive review of the evidence base for the Hanf-Model programs, rather our intention is to provide a template of sorts from which agencies and clinicians can make informed choices about how and why they are using one program versus another, as well as how to make inform flexible use one program or combination of practice elements across programs, to best meet the needs of child clients and their families. Clinical implications and directions for future work are discussed.
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Affiliation(s)
- Laura A Kaehler
- Children's Advocacy Services of Greater St. Louis, University of Missouri, St. Louis, MO, USA
| | - Mary Jacobs
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Hage SM, Romano JL, Conyne RK, Kenny M, Matthews C, Schwartz JP, Waldo M. Best Practice Guidelines on Prevention Practice, Research, Training, and Social Advocacy for Psychologists. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000006291411] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preventive interventions have been shown to successfully aid the development of children, youths, and adults and avert maladjustment in individuals at risk for negative outcomes. Continued scientific advancement of preventive interventions is crucial to further the health of U.S. children, youths, and families. This article presents 15 best practice guidelines on prevention practice, research, training, and social advocacy for psychology. These guidelines articulate clear standards and a framework for moving the profession toward improving the well-being of a greater number of individuals and communities. The guidelines are intended to assist psychologists in evaluating their preparation for engaging in prevention work and in furthering their understanding through increased knowledge, skills, and experience in prevention.
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Simon AE, Pastor PN, Reuben CA, Huang LN, Goldstrom ID. Use of Mental Health Services by Children Ages Six to 11 With Emotional or Behavioral Difficulties. Psychiatr Serv 2015; 66:930-7. [PMID: 25975889 PMCID: PMC4654459 DOI: 10.1176/appi.ps.201400342] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors reported use of mental health services among children in the United States between ages six and 11 who were described by their parents as having emotional or behavioral difficulties (EBDs). METHODS Using data from the 2010-2012 National Health Interview Survey, the authors estimated the national percentage of children ages six to 11 with serious or minor EBDs (N=2,500) who received treatment for their difficulties, including only mental health services other than medication (psychosocial services), only medication, both psychosocial services and medication, and neither type of service. They calculated the percentage of children who received school-based and non-school-based psychosocial services in 2011-2012 and who had unmet need for psychosocial services in 2010-2012. RESULTS In 2010-2012, 5.8% of U.S. children ages six to 11 had serious EBDs and 17.3% had minor EBDs. Among children with EBDs, 17.8% were receiving both medication and psychosocial services, 28.8% psychosocial services only, 6.8% medication only, and 46.6% neither medication nor psychosocial services. Among children with EBDs in 2011-2012, 18.6% received school-based psychosocial services only, 11.4% non-school-based psychosocial services only, and 17.3% both school- and non-school-based psychosocial services. In 2010-2012, 8.2% of children with EBDs had unmet need for psychosocial services. CONCLUSIONS School-age children with EBDs received a range of mental health services, but nearly half received neither medication nor psychosocial services. School-based providers played a role in delivering psychosocial services, but parents reported an unmet need for psychosocial services among some children.
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Affiliation(s)
- Alan E Simon
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Patricia N Pastor
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Cynthia A Reuben
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Larke N Huang
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Ingrid D Goldstrom
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
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Kanu M, Hepler N, Labi H. Assessing Effectiveness of Students Taking a Right Stand (STARS) Nashville Student Assistance Programs. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2015. [DOI: 10.1080/1067828x.2013.829015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Weiss CL, Blizzard AM, Vaughan C, Sydnor-Diggs T, Edwards S, Stephan SH. Supporting the transition from inpatient hospitalization to school. Child Adolesc Psychiatr Clin N Am 2015; 24:371-83. [PMID: 25773330 DOI: 10.1016/j.chc.2014.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The School Transition Program (STP) is a 3-month intervention developed to address the unique needs of youth transitioning back to school from an inpatient psychiatric hospitalization. The STP focuses on promoting communication across school, home, and hospital. It includes psychoeducation, emotional support for caregivers, and the creation of transition plans in collaboration with school staff and families. Matching interventions to the academic, social, emotional/behavioral needs of these youth and increasing support to their caregivers has the potential to ease stress, reduce challenges and promote success during and after the transition period.
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Affiliation(s)
- Catharine L Weiss
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MD 21201, USA.
| | - Angela M Blizzard
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MD 21201, USA
| | - Courtney Vaughan
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MD 21201, USA
| | - Tierra Sydnor-Diggs
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MD 21201, USA
| | - Sarah Edwards
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MD 21201, USA
| | - Sharon Hoover Stephan
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MD 21201, USA
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21
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Becker KD, Buckingham SL, Brandt NE. Engaging youth and families in school mental health services. Child Adolesc Psychiatr Clin N Am 2015; 24:385-98. [PMID: 25773331 DOI: 10.1016/j.chc.2014.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this article, an overview is provided of strategies to engage youth and their families in school mental health (SMH) services throughout the course of treatment. Resources are outlined to help SMH providers determine which strategies are most suitable for youth and their families, based on outcomes desired, barriers to engagement, and stage of treatment. Four case vignettes are presented to describe implementation of these strategies.
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Affiliation(s)
- Kimberly D Becker
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Room 424, Baltimore, MD 21201, USA.
| | - Sara L Buckingham
- Human Services Psychology Program, University of Maryland, Baltimore County, 1000 Hilltop Circle, Math/Psych Room 312, Baltimore, MD 21250, USA
| | - Nicole Evangelista Brandt
- Department of Psychology, Columbus State Community College, 550 East Spring Street, Room 335B, Columbus, OH 43215, USA
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23
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Savina E, Simon J, Lester M. School Reintegration Following Psychiatric Hospitalization: An Ecological Perspective. CHILD & YOUTH CARE FORUM 2014. [DOI: 10.1007/s10566-014-9263-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beecham J. Annual research review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders. J Child Psychol Psychiatry 2014; 55:714-32. [PMID: 24580503 PMCID: PMC4657502 DOI: 10.1111/jcpp.12216] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Resources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses. SCOPE AND METHODS The aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012. FINDINGS Sixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n = 15), conduct disorder (CD; n = 7), and anxiety or depression (n = 8). CONCLUSION Only 14 studies used a cost perspective wider than health care; most included education costs (n = 11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders.
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Affiliation(s)
- Jennifer Beecham
- Personal Social Services Research Unit, University of KentCanterbury, UK
- London School of Economics and Political ScienceCanterbury, UK
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25
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Stability and Change of ODD, CD and ADHD Diagnosis in Referred Preschool Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 42:1213-24. [DOI: 10.1007/s10802-014-9869-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Basa FB, Harris M, Syed MA, Le Noury J, Healy D. Mental health admissions in paediatric populations in North Wales: two cohorts compared 1875-1924 and 1994-2008. BMJ Open 2014; 4:e004331. [PMID: 24682574 PMCID: PMC3975741 DOI: 10.1136/bmjopen-2013-004331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate frequency of under-18s admitted to mental health services (MHS) in North West Wales (NWW) between 1875 and 2008. There are claims that 1 in 10 children have a mental illness, but there are little data on their inpatient MHS utilisation. SETTING Looking at admissions at the secondary care level, three data samples were included; the first comprises historical asylum admissions, the second comprises contemporary admissions to acute psychiatric beds, and the third comprises admissions to district general hospital (DGH) beds that resulted in a mental health coding. PARTICIPANTS All were under 18. There were 65 historical patients, 41 contemporary mental illness admissions and 943 DGH admissions. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were diagnoses based on case notes of the historical cohort between 1875 and 1924, as well as details of paediatric admissions to MHS from 1994 to 2008 and paediatric admissions with a mental health component to the DGH in NWW. RESULTS The incidence of admission to a mental health bed was 1.55 per year in the historical cohort compared with 2.9 in the contemporary. The overall incidence of admission to any bed in the contemporary cohort was 129 patients per year. There has been a twofold increase in the incidence of admissions for schizophrenia and related psychosis, but this most likely stems from an earlier age of admission rather than a true increase. CONCLUSIONS There is a greater frequency of hospital admissions for youth under the age of 18 in NWW for mental health today than previously. The rates reported in the DGH sample are consistent with data from community surveys of patients meeting criteria for mental disorders and complement such data when it comes to planning for paediatric MHS. However, they also raise questions about the boundaries between disease and distress.
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Affiliation(s)
- Fouad B Basa
- Hergest Unit, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Margret Harris
- North Wales Department of Psychological Medicine, Hergest Unit, Penrhosgarnedd, Bangor, Gwynedd, UK
| | - Mujahid Ali Syed
- Hergest Unit, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Joanna Le Noury
- North Wales Department of Psychological Medicine, Hergest Unit, Penrhosgarnedd, Bangor, Gwynedd, UK
| | - David Healy
- North Wales Department of Psychological Medicine, Hergest Unit, Penrhosgarnedd, Bangor, Gwynedd, UK
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Cook BL, Zuvekas SH, Carson N, Wayne GF, Vesper A, McGuire TG. Assessing racial/ethnic disparities in treatment across episodes of mental health care. Health Serv Res 2014; 49:206-29. [PMID: 23855750 PMCID: PMC3844061 DOI: 10.1111/1475-6773.12095] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment. STUDY DESIGN We analyzed whites, blacks, and Latinos with probable mental illness from Panels 9-13 of the Medical Expenditure Panel Survey, assessing disparities at the beginning, middle, and end of episodes of care (initiation, adequate care, having an episode with only psychotropic drug fills, intensity of care, the mixture of primary care provider (PCP) and specialist visits, use of acute psychiatric care, and termination). FINDINGS Compared with whites, blacks and Latinos had less initiation and adequacy of care. Black and Latino episodes were shorter and had fewer psychotropic drug fills. Black episodes had a greater proportion of specialist visits and Latino episodes had a greater proportion of PCP visits. Blacks were more likely to have an episode with acute psychiatric care. CONCLUSIONS Disparities in adequate care were driven by initiation disparities, reinforcing the need for policies that improve access. Many episodes were characterized only by psychotropic drug fills, suggesting inadequate medication guidance. Blacks' higher rate of specialist use contradicts previous studies and deserves future investigation. Blacks' greater acute mental health care use raises concerns over monitoring of their treatment.
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Affiliation(s)
- Benjamin Lê Cook
- Address correspondence to Benjamin Lê Cook, Ph.D., M.P.H., Department of Psychiatry, Harvard Medical School, Center for Multicultural Mental Health Research, 120 Beacon Street, 4th Floor, Somerville,MA02143; e-mail: . Samuel H. Zuvekas, Ph.D., is with the Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD. Nicholas Carson, M.D., F.R.C.P.C., is with the Department of Psychiatry, HarvardMedical School, Center for MulticulturalMental Health Research, Somerville, MA.Geoffrey Ferris Wayne, M.A., is with the Center for Multicultural Mental Health Research, Somerville, MA. AndrewVesper, Ph.D., is with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Harvard University, Cambridge, MA. Thomas G. McGuire, Ph.D., is with the Department of Health Care Policy, Harvard Medical School, Boston, MA
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Eklund K, Renshaw TL, Dowdy E, Jimerson SR, Hart SR, Jones CN, Earhart J. Early Identification of Behavioral and Emotional Problems in Youth: Universal Screening versus Teacher-Referral Identification. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/bf03340954] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Screening for Behavioral and Emotional Risk Versus Traditional School Identification Methods. SCHOOL MENTAL HEALTH 2013. [DOI: 10.1007/s12310-013-9109-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Szczepaniak D, McHenry MS, Nutakki K, Bauer NS, Downs SM. The prevalence of at-risk development in children 30 to 60 months old presenting with disruptive behaviors. Clin Pediatr (Phila) 2013; 52:942-9. [PMID: 23836809 DOI: 10.1177/0009922813493832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study assessed the prevalence of failed developmental screens in 30- to 60-month-old children who presented with a behavioral complaint of disruptive behavior to a referral clinic. METHODS A retrospective chart review was performed in a specialty behavioral pediatric clinic. Outcome measures were obtained from children referred to the clinic with parental concern of disruptive behavior. RESULTS Out of 151 patients, 66% (99/151) had been screened for developmental delays with a formal screening instrument. Of these, 71% (70/99) failed developmental screening in one or more domains. CONCLUSIONS Preschoolers referred to a behavioral clinic for parental concerns of disruptive behaviors were more than 4 times more likely to be at risk for developmental delays than the general population, with a majority of suspected delays in communication and problem-solving domains. This finding suggests that developmental screening should be a part of the initial workup for children with disruptive behaviors.
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Banta JE, James S, Haviland MG, Andersen RM. Race/ethnicity, parent-identified emotional difficulties, and mental health visits among California children. J Behav Health Serv Res 2013; 40:5-19. [PMID: 23070565 DOI: 10.1007/s11414-012-9298-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Variability in mental health services utilization by race/ethnicity was evaluated with a Behavioral Model approach. Subjects were 17,705 children 5 to 11 years of age in the 2005, 2007, and 2009 California Health Interview Surveys. Parents identified minor emotional difficulties in 18.7% of these children (ranging from 14.8% in Asians to 24.4% in African Americans) and definite or severe difficulties in 7.4% (5.5% in Asians to 9.7% in "other race"). Overall, 7.6% of children had at least one mental health visit in the prior year (2.3% in Asians to 11.2% in African Americans). Parent-identified need was the most salient predictor of mental health visits for all racial/ethnic groups. Beyond need, no consistent patterns could be determined across racial/ethnic groups with regard to the relationship between contextual, predisposing, and enabling measures and mental health service utilization. Different factors operated for each racial/ethnic group, suggesting the need for studies to examine mental health need, mental health service use, and determinants by racial/ethnic subgroup. These findings suggest that a "one-size-fits-all approach" with regard to policies and practices aimed at reducing mental health disparities will not be effective for all racial/ethnic groups.
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Affiliation(s)
- Jim E Banta
- Department of Health Policy and Management, Loma Linda University School of Public Health, Loma Linda, CA 92350, USA.
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Leonardi S, Pecoraro R, Garozzo MT, Coco A, La Rosa M. The cross-talk between family and pediatrician: The case of bronchial asthma. Health (London) 2013. [DOI: 10.4236/health.2013.52a041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jacob MK, Larson JC, Craighead WE. Establishing a telepsychiatry consultation practice in rural Georgia for primary care physicians: a feasibility report. Clin Pediatr (Phila) 2012; 51:1041-7. [PMID: 22523276 DOI: 10.1177/0009922812441671] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE One approach to solving mental health care disparity issues in rural areas is by establishing a telepsychiatry consultation practice for children, in which a psychiatrist sees a child via videoconferencing for a limited number of sessions and then provides a treatment plan to that child's primary care physician and family. METHOD The present study offered a 2-session telepsychiatry consultation clinic, consisting of a psychiatric evaluation session and a recommendation session, with patients located remotely in rural Georgia. RESULTS Fifteen consultations with children aged 4 to 18 years (M = 9.73, SD = 3.39) with varying diagnoses were completed. Parental satisfaction with the telepsychiatry consultation model was high, overall mean of 4.58 (SD = 0.63) on a 5-point scale (n = 11). CONCLUSION Establishing a child telepsychiatry consultation practice is feasible in rural areas. This report describes the benefits and challenges of our telepsychiatry consultation clinic with rural pediatric patients.
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Affiliation(s)
- Maryann K Jacob
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30306, USA.
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Strickland J, Hopkins J, Keenan K. Mother-teacher agreement on preschoolers' symptoms of ODD and CD: does context matter? JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:933-43. [PMID: 22661105 DOI: 10.1007/s10802-012-9622-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aims of this study were to examine mother-teacher agreement on oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms and diagnoses in preschool children; to determine if context is a source of disagreement; and to explore if sex, referral status, and age moderated agreement rates. Participants included 158 male and 139 female 3- to 5-year old preschool children, their mothers, and teachers. A structured interview, the Kiddie-Disruptive Behavior Disorder Schedule was used for maternal report and teachers completed the Early Childhood Inventory. Results indicated that mothers reported more symptoms and diagnoses of ODD and CD than teachers, and mother-teacher agreement on both ODD and CD symptoms and diagnoses was low. Level of mother-teacher agreement increased when reporting on behavior in the same context; however, the rates remain modest. Referral status increased the likelihood of mother and teacher agreement on several ODD and CD symptoms, as well as ODD and CD diagnosis. These data suggest that context plays a role in mother-teacher agreement in the assessment of young children's ODD and CD symptoms.
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Affiliation(s)
- Jennifer Strickland
- Illinois Institute of Technology, College of Psychology, Chicago, IL 60616-3793, USA.
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Rotheram-Borus MJ, Swendeman D, Chorpita BF. Disruptive innovations for designing and diffusing evidence-based interventions. AMERICAN PSYCHOLOGIST 2012; 67:463-76. [PMID: 22545596 PMCID: PMC3951837 DOI: 10.1037/a0028180] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evidence-based therapeutic and preventive intervention programs (EBIs) have been growing exponentially. Yet EBIs have not been broadly adopted in the United States. In order for our EBI science to significantly reduce disease burden, we need to critically reexamine our scientific conventions and norms. Innovation may be spurred by reexamining the traditional biomedical model for validating, implementing, and diffusing EBI products and science. The model of disruptive innovations suggests that we reengineer EBIs on the basis of their most robust features in order to serve more people in less time and at lower cost. A disruptive innovation provides a simpler and less expensive alternative that meets the essential needs for the majority of consumers and is more accessible, scalable, replicable, and sustainable. Examples of disruptive innovations from other fields include minute clinics embedded in retail chain drug stores, $2 generic eyeglasses, automated teller machines, and telemedicine. Four new research approaches will be required to support disruptive innovations in EBI science: synthesize common elements across EBIs; experiment with new delivery formats (e.g., consumer controlled, self-directed, brief, paraprofessional, coaching, and technology and media strategies); adopt market strategies to promote and diffuse EBI science, knowledge, and products; and adopt continuous quality improvement as a research paradigm for systematically improving EBIs, based on ongoing monitoring data and feedback. EBI science can have more impact if it can better leverage what we know from existing EBIs in order to inspire, engage, inform, and support families and children to adopt and sustain healthy daily routines and lifestyles.
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Rodriguez J, Hoagwood KE, Gopalan G, Olin S, McKay MM, Marcus SM, Radigan M, Chung M, Legerski J. Engagement in Trauma-Specific CBT for Youth Post-9/11. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2012; 20:1063426611428157. [PMID: 22754272 PMCID: PMC3384551 DOI: 10.1177/1063426611428157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Treatment participation was examined among youth enrolled in an evaluation of cognitive behavioral therapy (CBT) for trauma following the 9/11 World Trade Center disaster. Staff at nine agencies serving a predominantly low-income ethnically diverse population were trained to deliver CBT and structured engagement strategies. Four hundred and forty-five youth ages 5-19 were eligible for CBT, and 417 (94%) received at least one treatment session. Pretreatment and treatment show rates and overall dose were examined. Treatment participation rates were higher than those typically reported in community studies of children's mental health services. Regression analyses indicated variability across sites in treatment show rates with the highest rates at where services were delivered in schools. However, sites, demographic factors and trauma symptoms accounted for a small amount of variance in treatment participation overall. The study suggests structured engagement strategies, linked to evidence-based treatments may improve treatment participation for youth.
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Luebbe AM, Elledge LC, Kiel EJ, Stoppelbein L. Cortisol Predicts Behavioral Dysregulation and Length of Stay Among Children Admitted for Psychiatric Inpatient Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:227-38. [DOI: 10.1080/15374416.2012.652000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Barrett PM, Pahl KM. School-Based Intervention: Examining a Universal Approach to Anxiety Management. ACTA ACUST UNITED AC 2012. [DOI: 10.1375/ajgc.16.1.55] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractAnxiety disorders are among the most common mental health problems affecting children and adolescents. Current estimates indicate that 1 in 5 children or 4 to 6 students within a classroom of 30 children are at risk for developing an anxiety disorder (Boyd, Kostanski, Gullone, Ollendick, & Shek, 2000). Of these children, many will not receive clinical intervention. The school environment is the optimal setting to address this issue and to minimise the risk and prevent the development of anxiety disorders. This article examines the importance of early intervention and prevention within the school setting through an examination of the risk and protective factors of anxiety and the comparability of three approaches to prevention in schools — selective, indicated, and universal approaches. All three prevention approaches are discussed along with the advantages and disadvantages of each. The applicability of the universal approach to prevention is discussed in relation to the FRIENDS for Life (FRIENDS) program (Barrett, 2004, 2005) and its implementation within schools. The FRIENDS program is an evidence-based, cognitive–behavioural anxiety program for children and youth. It is the only evidence-based program endorsed by the World Health Organization as an effective program for the prevention and treatment of anxiety and depression in children and youth.
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Pedrini L, Colasurdo G, Costa S, Fabiani M, Ferraresi L, Franzoni E, Masina F, Moschen R, Neviani V, Palazzi S, Parisi R, Parmeggiani A, Preti A, Ricciutello C, Rocchi MBL, Sisti D, Squarcia A, Trebbi S, Turchetti D, Visconti P, Tullini A, de Girolamo G. The characteristics and activities of child and adolescent mental health services in Italy: a regional survey. BMC Psychiatry 2012; 12:7. [PMID: 22289204 PMCID: PMC3310734 DOI: 10.1186/1471-244x-12-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 01/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date, no studies have assessed in detail the characteristics, organisation, and functioning of Child and Adolescent Mental Health Services (CAMHS). This information gap represents a major limitation for researchers and clinicians because most mental disorders have their onset in childhood or adolescence, and effective interventions can therefore represent a major factor in avoiding chronicity. Interventions and mental health care are delivered by and through services, and not by individual, private clinicians, and drawbacks or limitations of services generally translate in inappropriateness and ineffectiveness of treatments and interventions: therefore information about services is essential to improve the quality of care and ultimately the course and outcome of mental disorders in childhood and adolescence.The present paper reports the results of the first study aimed at providing detailed, updated and comprehensive data on CAMHS of a densely populated Italian region (over 4 million inhabitants) with a target population of 633,725 subjects aged 0-17 years. METHODS Unit Chiefs of all the CAMHS filled in a structured 'Facility Form', with activity data referring to 2008 (data for inpatient facilities referred to 2009), which were then analysed in detail. RESULTS Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0-17 years. All outpatient units were well equipped and organized and all granted free service access. In 2008, approximately 6% of the target population was in contact with outpatient CAMHS, showing substantial homogeneity across the eleven areas thereby. Most patients in contact in 2008 received a language disorder- or learning disability diagnosis (41%). First-ever contacts accounted for 30% of annual visits across all units. Hospital bed availability was 5 per 100,000 inhabitants aged 0-17 years. CONCLUSION The percentage of young people in contact with CAMHS for mental disorders is in line with those observed in previous epidemiological studies. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and it is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours (e.g., nights and holidays).
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Affiliation(s)
- Laura Pedrini
- IRCCS Centro San Giovanni di Dio-Fatebenefratelli, Brescia-Italy
| | | | - Stefano Costa
- UOS Psichiatria e Psicoterapia età evolutiva, Ospedale Maggiore, Bologna-Italy
| | | | | | | | | | - Renato Moschen
- U.O. NPI Ospedaliera-Psicopatologia dell'Adolescenza e U.O. NPI Ospedaliera-Neurologia RIMINI-Italy
| | | | | | | | - Antonia Parmeggiani
- IRCCS Institute of Neurological Sciences and Department of Neurological Sciences, University of Bologna
| | - Antonio Preti
- Department of Psychology, University of Cagliari-Italy
| | | | | | - Davide Sisti
- Institute of Biomathematics, University of Urbino-Italy
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Tharayil PR, Sigrid J, Morgan R, Freeman K. Examining Outcomes of Acute Psychiatric Hospitalization among Children. SOCIAL WORK IN MENTAL HEALTH 2012; 10:205-232. [PMID: 23946699 PMCID: PMC3740792 DOI: 10.1080/15332985.2011.628602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Within the past two decades, few studies have examined outcomes of acute psychiatric hospitalization among children, demonstrating change in emotional and behavioral functioning. A secondary analysis of pre-test/post-test data collected on 36 children was conducted, using the Target Symptom Rating (TSR). The TSR is a 13-item measure with two subscales - Emotional Problems and Behavioral Problems and was designed for evaluation of outcome among children and adolescents in acute inpatient psychiatric settings. Results of this study, its limitations, and the barriers encountered in the implementation of the TSR scale as part of routine clinical practice are discussed.
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Sander JB, Sharkey JD, Groomes AN, Krumholz L, Walker K, Hsu JY. Social Justice and Juvenile Offenders: Examples of Fairness, Respect, and Access in Education Settings. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2011. [DOI: 10.1080/10474412.2011.620816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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McKay MM, Gopalan G, Franco L, Assael KD, Chacko A, Jackson J, Fuss A. A Collaboratively Designed Child Mental Health Service Model: Multiple Family Groups for Urban Children with Conduct Difficulties. RESEARCH ON SOCIAL WORK PRACTICE 2011; 21:664-674. [PMID: 22194642 PMCID: PMC3243310 DOI: 10.1177/1049731511406740] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.
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Do children with developmental disabilities and mental health conditions have greater difficulty using health services than children with physical disorders? Matern Child Health J 2011; 15:634-41. [PMID: 20364366 DOI: 10.1007/s10995-010-0597-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this study is to determine whether achievement of the Maternal and Child Health Bureau core outcome ease of use of health services differs between children with developmental disabilities, mental health conditions and physical disorders. We analyzed data from the 2005 National Survey of Children with Special Health Care Needs. Children with special health care needs were classified into 4 health condition groups: developmental disabilities (DD), mental health conditions (MH), physical disorders (PD) and multiple conditions. The outcome measure was 'difficulty using services'. We conducted bivariate and multivariate analyses to determine the associations between the health condition groups and the outcome. Of the CSHCN included in the study, 2.6% had DD, 12.9% had MH, 49.9% had PD and 34.6% belonged to multiple conditions group. Four percent of CSHCN with PD, 17% of those with DD, 13% of those with MH and 20% of those in the multiple conditions group had difficulty using services. In multivariate analyses, CSHCN with DD had 2.3 times and MH conditions had 2.6 times the odds of having difficulty using services compared to those with PD. Existing programs for CSHCN should be evaluated for the adequacy of services provided to children with DD and MH. Future studies should evaluate how developmental disabilities and mental health policies affect navigating the health care system for this population.
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Gaylord-Harden NK, Elmore CA, Campbell CL, Wethington A. An examination of the tripartite model of depressive and anxiety symptoms in African American youth: stressors and coping strategies as common and specific correlates. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2011; 40:360-74. [PMID: 21534048 DOI: 10.1080/15374416.2011.563467] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of the current study was to examine the tripartite model of depression and anxiety in a community-based sample of 278 African American adolescents (M age = 12.89) from low-income communities and to identify stressors and coping strategies that were associated with the specific features of each disorder. Participants reported on depression, anxiety, stressors, and coping strategies. As predicted, the three-factor structure of the tripartite model was a valid representation of anxiety and depression in African American youth. Further, stressors and coping strategies showed specific associations to features of depression and anxiety. The findings provide evidence of factors that may help to distinguish between internalizing symptoms in African American youth.
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Affiliation(s)
- Noni K Gaylord-Harden
- Department of Psychology, Loyola University Chicago, 1032 West Sheridan Road, Chicago, IL 60660, USA.
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Development of a measure to assess the implementation of children's systems of care: the Systems of Care Implementation Survey (SOCIS). J Behav Health Serv Res 2011; 38:288-302. [PMID: 21590313 DOI: 10.1007/s11414-011-9239-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The children's system of care framework has been extensively implemented in the U.S. Since its inception in 1993, the Comprehensive Community Mental Health Services for Children and Their Families Program has invested in excess of $1 billion supporting the development of systems of care in 164 grantee sites across the country. Despite these efforts to implement children's systems of care nationally, little is known about the extent to which the principles and values actually have been put into practice outside of the funded grantee sites. This paper describes the development of the Systems of Care Implementation Survey, a measure designed specifically for the first ever study assessing the level of implementation of factors contributing to effective children's systems of care in a nationally representative sample of counties throughout the U.S.
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Kutcher S, McDougall A. Problems with access to adolescent mental health care can lead to dealings with the criminal justice system. Paediatr Child Health 2011; 14:15-8. [PMID: 19436458 DOI: 10.1093/pch/14.1.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2008] [Indexed: 11/14/2022] Open
Abstract
Mental disorders collectively constitute the largest burden of disease in young people. They have substantial negative short- and long-term outcomes across many domains, yet early identification and effective intervention can improve outcomes and can often lead to recovery. Unfortunately, many young people do not receive the mental health care they require and may consequently enter the justice system. Studies of incarcerated youths show that up to 70% of them have mental disorders. Many of these youth receive primarily custodial care. A variety of social, legal and medical interventions can and should be implemented to ensure that young people suffering from mental disorders do not inappropriately enter the justice system due to lack of access to health care and other services.
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Affiliation(s)
- Stanley Kutcher
- Sun Life Financial Chair in Adolescent Mental Health, Halifax, Nova Scotia
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Affiliation(s)
- Jason L. Whipple
- Department of Psychology, University of Alaska Fairbanks, Fairbanks, Alaska 99775;
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Swanson ME, Wall S, Kisker E, Peterson C. Health disparities in low-income families with infants and toddlers: needs and challenges related to disability. J Child Health Care 2011; 15:25-38. [PMID: 21317168 DOI: 10.1177/1367493510387951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines disparities in health status, health care utilization, insurance coverage and satisfaction in US low-income parents of infants and toddlers with disabilities compared to low-income parents of children without disabilities. The Early Head Start Research and Evaluation Project is a longitudinal study involving 2087 families in 17 communities across the United States. Families completed interviews at enrollment and at 7, 16, and 28 months after enrollment. Descriptive analyses were conducted to characterize children's status in terms of health, health care use, and insurance coverage. Children with disabilities were more likely to experience poor health and to use more health care services. Parents of children with disabilities were more likely to report that medical care was inadequate. Hispanic children were less likely to experience excellent health. Hispanic parents were less likely to have health insurance or to report that their medical care was adequate. Low-income parents of young children with disabilities perceived their children as less healthy, more vulnerable and needing more health services. This study demonstrates the importance of providing accessible, culturally-competent services to this vulnerable population.
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Affiliation(s)
- Mark E Swanson
- Centers for Disease Control and Prevention, Atlanta, USA.
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Gona JK, Mung'ala-Odera V, Newton CR, Hartley S. Caring for children with disabilities in Kilifi, Kenya: what is the carer's experience? Child Care Health Dev 2011; 37:175-83. [PMID: 20645990 PMCID: PMC3072473 DOI: 10.1111/j.1365-2214.2010.01124.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Carers of children with disabilities have repeatedly highlighted their feelings of discrimination, stigma and exclusion in many domains of their lives. There is little research from Africa addressing these issues. This study investigated the challenges encountered by these carers and the mechanisms of coping with these challenges while caring for children with disabilities in a poor rural setting in Kenya. METHODS Thirty-five in-depth interviews were conducted with 20 carers, 10 community members and 5 primary school teachers. Ten unstructured observations were also conducted in home environments to observe mechanisms used in meeting the needs of the children with disabilities. All interviews were tape-recorded, transcribed and translated from the local dialect. Note-taking was performed during all the observations. Data were stored in NVivo software for easy retrieval and management. RESULTS The arrival of a disabled child severely impairs the expectations of carers. Hospital staff underestimate carers' emotional distress and need for information. Fear for the future, stress, rumour-mongering and poverty are encountered by carers. As they grapple with lost expectations, carers develop positive adaptations in the form of learning new skills, looking for external support and in some cases searching for cure for the problem. For their emotional stability, carers apply spiritual interventions and sharing of experiences. CONCLUSION Despite the challenges faced by the carers, values and priorities in adaptation to the challenges caused by the child's disability were applied. It is recommended that these experiences are considered as they may influence programmes that address the needs of children with disabilities.
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Affiliation(s)
- J K Gona
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya.
| | - V Mung'ala-Odera
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research InstituteKilifi, Kenya
| | - C R Newton
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research InstituteKilifi, Kenya,Neuroscience Unit, Institute of Child Health, University College LondonLondon,Clinical Research Unit, London School of Hygiene and Tropical MedicineLondon
| | - S Hartley
- University of East AngliaNorwich, Norfolk, UK
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Examining Perceptions About Mental Health Care and Help-Seeking Among Rural African American Families of Adolescents. J Youth Adolesc 2011; 40:1118-31. [DOI: 10.1007/s10964-010-9627-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 12/30/2010] [Indexed: 11/27/2022]
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